GPs’ role security and therapeutic commitment in managing alcohol problems: a randomised controlled trial of a tailored improvement programme
1 Radboud university medical center, Scientific Institute for Quality of Healthcare (IQ healthcare), P.O. Box 9101, 114 IQ healthcare, 6500 HB Nijmegen, The Netherlands
2 Institute of Health and Society, Medical Faculty, Baddiley-Clark Building, Richardson Road, Newcastle NE2 4AX, UK
3 HAN University of Applied Sciences, P.O. Box 6960, 6503 GL Nijmegen, The Netherlands
BMC Family Practice 2014, 15:70 doi:10.1186/1471-2296-15-70Published: 17 April 2014
General practitioners with more positive role security and therapeutic commitment towards patients with hazardous or harmful alcohol consumption are more involved and manage more alcohol-related problems than others. In this study we evaluated the effects of our tailored multi-faceted improvement implementation programme on GPs’ role security and therapeutic commitment and, in addition, which professional related factors influenced the impact of the implementation programme.
In a cluster randomised controlled trial, 124 GPs from 82 Dutch general practices were randomised to either the intervention or control group. The tailored, multi-faceted programme included combined physician, organisation, and patient directed alcohol-specific implementation strategies to increase role security and therapeutic commitment in GPs. The control group was mailed the national guideline and patients received feedback letters. Questionnaires were completed before and 12 months after start of the programme. We performed linear multilevel regression analysis to evaluate effects of the implementation programme.
Participating GPs were predominantly male (63%) and had received very low levels of alcohol related education before start of the study (0.4 h). The programme increased therapeutic commitment (p = 0.005; 95%-CI 0.13 – 0.73) but not role security (p = 0.58; 95%-CI −0.31 – 0.54). How important GPs thought it was to improve their care for problematic alcohol consumption, and the GPs’ reported proportion of patients asked about alcohol consumption at baseline, contributed to the effect of the programme on therapeutic commitment.
A tailored, multi-faceted programme aimed at improving GP management of patients with hazardous and harmful alcohol consumption improved GPs’ therapeutic commitment towards patients with alcohol-related problems, but failed to improve GPs’ role security. How important GPs thought it was to improve their care for problematic alcohol consumption, and the GPs’ reported proportion of patients asked about alcohol consumption at baseline, both increased the impact of the programme on therapeutic commitment. It might be worthwhile to monitor proceeding of role security and therapeutic commitment throughout the year after the implementation programme, to see whether the programme is effective on short term but faded out on the longer term.
ClinicalTrials.gov Identifier: NCT00298220